Bucket laundry! This is before Elliott installed the large umbrella to keep the drips from upstairs off our backs. In the course of an average seated urination we could expect 6-8 fat drops, plumbing source unknown. Now it feels like a beach party. Management aware and uninterested. Elliott is off on a two-night adventure in Axum, home of famed and impossibly large menhirs. I wonder if they sell Obelix figurines. He left this morning taking a bejaj to the airport at 7:30 and called by 1pm from a bicycle by a rock quarry and sounding cheery.
This will be quick since the Hard Rock Caffe (which just had a rockin' "Ester" celebration (double sic)) is closing. And there won't be pictures since Mr. Ryan has the camera in Axum.
Monday morning we went to dermatology clinic for the first time and sorely regretted not having gone earlier and often. Dr. Kass and Dr. Sarah (visiting from Duke's faculty) saw an amazing display of AIDS manifestations (oral Kaposi's, proximal subungual onychomycosis), two new and one follow-up leprosy cases with surprisingly palpable ulnar nerves and extensive auricular and genital lesions (one poor teenager also had a body louse who was nice enough to hold still for capture and suffocation in alcohol), severe hyperpigmentation and hyperkeratosis of the face, some good ol' fungal infections and -- even in the dry season -- acne. I'll spare you the photos...
Sonal and I had a busy and good day. Morning report was a comically poorly prepared intern presentation on treatment of diabetic ketoacidosis. The case presentation culminated in the statement, "Unable to find follow-up shit" which, amazingly, did not elicit a single giggle; I guess they don't learn much slang. Although he was referring to the charting sheet which documented urine output and blood sugars, we appreciated the unintended sentiment.
We had asked our host, Dr. Shitaye, to meet with us and debrief about our time here and our combined Swedish-Gondar hopes for the future of our collaboration. I feel much more hopeful and constructive than I did a week ago and we're putting together a document which should grease some Swedish wheels for the upcoming year. It turns out that part of the reason we have been having a different experience here than our predecessors is that there are, due to some scheduling SNAFUs, no medical students on campus at all. In comparison, there will be several months next year during which there will be 440 here! Please keep in mind that there are under ten full-time faculty in the internal medicine department to teach 30 interns, 10 residents, and all those students.
After morning meeting we ran into Dejen, our wonderful guide from the Simiens. His mother-in-law was admitted to the Women's C Ward yesterday with end-stage renal disease, acute volume loss (dehydration) from several days of reaction to her new anti-tuberculosis medications, and resultant coma. It was remarkable to feel such a connection to this woman and her family and to try to interpret medical information for Dejen and his pregnant wife. We do this all the time at home so the new aspects involved making sure we understood everything about the patient's care (easier since we discussed her at the END of 3 hours of bed-side rounding during which he had constantly pressed the interns to speak more loudly and had gained a good conversational collegiality with the new attending and excellent resident), navigating the family's desire for information from us while trying to reassure them that their mom was getting the best care available (true) and attempting not to undermine the primary relationship of the intern with the patient's family, and explaining that a creatinine of 10 (super bad kidney failure) with only a few drops of urine output meant that she would likely die without setting up regular dialysis (machines that act like kidneys to filter blood a few times a week for many hours) in Addis which is an impossibility.
Closing time... skip ahead...
The afternoon meant diabetic clinic and, for some reason there were only two interns (usually 3 or 4) and no attendings with a full panel. Sonal and I precepted and we cranked through some really interesting patients, kept two potential DKA-ers out of the hospital, found important things to teach on for each patient, and had fun despite the heat and long hours.
We were sprung around 5:30, caught a taxi home, changed, found Han (Dutch physiotherapist friend), and walked up to the Gondar University track for our second run (success yesterday after recent discovery of said track). There were two pick-up soccer games in the dusty field in the middle and we ran a little over 2 miles. Han lectured us on core strengthening the entire time which both saved us from talking through this high-altitude dust-fest and just barely kept us from kicking rocks and gesticulating incomprehensibly at the 150 distracted and heckling socccer players and fans aged 3-33 (all male). Sonal and I care much less than we would otherwise because we're so happy to be running. Han is hypomanic and immune to heckling. We re-heated last night's hearty stew of potato, lentil, chick pea, onion, garlic, greens (we found greens!!!), and berbere.
Tomorrow we'll try to complete a survey to help us care for our Ethiopian patients at home in Seattle, a significant proportion of whom are originally from the Gondar region. Elliott will get back to town Thursday and we hit the Gondar airport for the final time Friday at noon to spend the weekend at Lalibela (more soon) for beautiful churches before hopping to Addis and then Rome. What a month!
xoxo, lights going off here...
-Liz
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